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– Privileged and Confidential –
July 19, 2010
BRIDGING THE DIGITAL
DIVIDE: MPOWERING CHILDREN AND
FAMILIES
Visiting Nurse Service of New York
– Privileged and Confidential –
VNSNY is the nation’s largest non-profit homecare
company
Company Overview
The Visiting Nurse Service of New York (VNSNY) is the
largest not-for-profit home health care organization in
the nation and was founded in 1893 by Lillian Wald, the
first public health nurse
A not-for-profit organization is a legally constituted organization whose objective is to provide services that are of benefit to others without any commercial or monetary profit.
Total Employees 14,300
Comprised of:
Registered Nurses 2,500
Physical, Occupational
and Speech Therapists 500
Social Workers: 600
Physicians, Nutritionists
and Psychologists 100
Home Health Aides 7,800
Home Attendants 600
– Privileged and Confidential –
VNSNY serves all of NYC and Nassau and Westchester
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We serve more than 130,000 patients and members
every year
Total Patients Served: 130,000
Total Professional Visits: 2.5 million
On any given day, VNSNY has more than 30,000 patient in our care; that’s more patients than are seen in one day in all NYC Hospitals
Diabetes and hypertension are the most frequent diagnoses
More than 25% of our patients speak languages other than English
The average age of a VNSNY patient is 73 years old. The youngest patient is only a few days old while the oldest is 113.
– Privileged and Confidential –
Acute Care
Rehabilitation
Congregate Care
Long Term Care
Family Care Services
End of Life
Children and Family Services
Medicaid and Medicare Health
Plans
Centers of Excellence
Programs
Visiting MD
Infusion
Community Mental Health
Services
Private Care
Community Outreach
VNSNY is both a payer and a provider and provides
a broad range of services to our community
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Our community’s problem: NYC has an epidemic of
uncontrolled diabetes
Percentage of NYC residents with diabetes
100% = 8 million
13%87%
Cost to the System
– Diabetics cost the health system over
$9000 per annum more than a
healthy, non-Diabetic.
– Diabetes cost the US $218 Billion in
2008 and is growing at 7.5% per
anum over the past decade
Obstacles in Treatment, Behavior
Change, and Care Options
– About 2/3rds of children with Type 1
diabetes are not managing their
diabetes effectively, which creates a
lifetime of health costs
– Adverse events from poor
management include DKA (which can
result in death) and long-term
complications (including blindness,
kidney failure)
– Disparities in diabetes care have
been documented for minority and
low income communities
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VNSNY is doing its part to combat this epidemic
VNSNY Pediatric Diabetes
Care Management Program
Who are we serving?
50 adolescents (age 11-17) with Type 1
diabetes and an A1c level of 8+
Children are largely Hispanic, low
income/Medicaid with many psycho-
social and family issues
Children are referred from the Naomi
Berrie Center and Monetefiore
Where do they live?
The Bronx
Upper Manhattan
– Privileged and Confidential – 8
VNSNY is doing its part to combat this epidemic
What are we trying to accomplish?
Improve A1c levels
Reduce the rate of hospitalization
Reduce 911 calls
Reduce ER visits
Reduce severe
hypo/hyperglycemic events
Improve knowledge, self care
behaviors, and family interaction
around diabetes
VNSNY Pediatric Diabetes
Care Management Program
– Privileged and Confidential – 9
CDE conducts
education
sessions
CDE/SW provides
care management
[Via Phone and
Well Doc application]
CDE/SW
conducts
lifestyle
sessions
CDE makes
admission visit
Our service delivery model utilizes in person and remote
interactions to ensure appropriate care across the continuum
WellDoc’s interactive cell phone
diabetes manager
• Client
• CDE / SW
• Physician
Service delivery model
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The WellDoc application is a critical tool to complement
our clinical activities and facilitate multi-disciplinary care
• Provides key clinical data access to CDE/SW (e.g., blood sugar readings) for
monitoring/education and as a self-management tool for the adolescents
•Serves as an integrated EMR for VNSNY clinicians to manage their caseload
•Increases communication with providers though web access to EMR and WellDoc
entries
•Pushes real-time, situation appropriate, structured educational content to the
children to enable self-care management wherever they are
•Engages children by providing them with their own phones (and encourages contact
with clinicians)
•Increases the collection of regular assessment data from the children by pushing
surveys to them on their phones
– Privileged and Confidential –
Clinician Web Portal:
Link to client’s cell phone
– Logbook
– Message Center
Clinical documentation
Management Reporting
Web Learning Library
Assessments
Physician access to view and enter
data
For Patients:
Logbook as a self-management
tool
Ability to share Logbook entries
with family members/physician
Message Center
Cell Phone Learning Library
Assessments pushed to phone
WellDoc: Key Features Phase I
– Privileged and Confidential –
WellDoc: Key Features Phase II
For Physicians:
Physician required to confirm
medication and targets (either
directly on web portal or via
fax) for patient to get access
Phase 2 features
For Patients:
DM Algorithm
Reminder System
Rules Engine (Alerts/Coaching)
Patient Web Portal (TBD)
– Privileged and Confidential – 13
Roadmaps
1. VNSNY assembles enough volume of patient data that shows outcomes and
demonstrates cost management value to key payors and stakeholders
2. VNSNY and its partners create a truly integrated solution (e.g. Well Doc data
directly uploads into VNSNY’s EMR and other’s clinical systems) to improve the
effectiveness of the solution
3. VNSNY offers this solution to multiple entities including Managed Care
organizations, Federal government, and NY State government
4. Expand offering to all age groups and to cover Type 2 and pre-
diabetes/childhood obesity
5. Evaluate other populations/disease states for inclusion
While we have started this as a charitable initiative, we
believe it has the potential for broader applications
– Privileged and Confidential –
WellDoc’s application
– Privileged and Confidential –
WellDoc’s application
– Privileged and Confidential –
WellDoc’s application
– Privileged and Confidential –
The program is off to a good start and is being received
well by the broader community
January 19, 2010
BIG CITY
What Lessons Those Carrots Are Teaching By SUSAN DOMINUSRemember New York City’s plan to reward students who excelled with cellphones? That plan fell
by the wayside, not because so many people thought it was absurd — after all, cellphones are not
allowed in New York City Schools — but because the project’s guru, the Harvard economist Roland
Fryer, decided to apply his energies elsewhere not long after the project began.
The plan seems to have had at least some ripple effect: Starting in February, the Visiting Nurse
Service of New York will begin a pilot program to try to combat Type 1 diabetes in young people
by offering more personalized health care — and to the young people, ages 11 to 17, who enroll,
they are offering specially programmed BlackBerrys.
The Blackberrys are, to some extent, a hard, cold incentive: participate in this diabetes care
management program, and get a hot gadget. But the BlackBerrys will have been programmed
specifically to help young people monitor their health, so that instead of writing in some notebook
what they’re eating and how they feel, the young people can do it on their phones, looking like
they’re blithely texting a friend instead of trying to avoid the emergency room. The phones function
like personal coaches, automatically turning on if a child turns it off after receiving one of the
preprogrammed prompts, say, to check blood sugar.
– Privileged and Confidential –
Press coverage of VNSNY’s Pediatric Diabetes Program
